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Center for Alcohol and Addiction Studies

PLNDP Medical Student Associate UPDATE
September 1999

Dear Colleague,

Since the start of the Physician Leadership in National Drug Policy (PLNDP) Medical Student Associates group, many members have expressed a desire for information to educate themselves and others. As mentioned in the first Medical Student Associate newsletter, we have placed onto our website much of the research collected by the PLNDP from the last two years. There are currently two research reports, November 1998 and March 1998,  and an Action Kit summarizing the major findings of these two reports. We’d also like to remind you that you can use the form on the website to request one or both PLNDP videos and that you can contact the Project Office for a hard copy of the Action Kit.

In order to make the PLNDP’s message more accessible and to highlight the important issue areas in drug policy, we are now offering another educational resource to you. Beginning with this one, each Medical Student Associate newsletter will be sent with two or three relevant journal articles focusing on a specific theme in drug policy. Abstracts for each of the articles will be included in the body of the newsletter for your convenience. Should you see an article you wish to disseminate to other Medical Student Associates, please send it to the National Project Office or email plndp@brown.edu with the citation of the article.

In addition to PLNDP Medical Student Associate newsletters, you will also soon be receiving monthly mailings from Join Together, a Boston-based program funded by the Robert Wood Johnson Foundation that supports community-based efforts to reduce, prevent, and treat substance abuse.  Historically, there has been a relative lack of involvement from the medical field in community matters, so PLNDP has formed collaborations with groups like Join Together in order that members of the medical community, including future physicians like us, can begin to gain a better sense of the community issues at stake in drug addiction and its treatment.

The topic for the articles accompanying this newsletter is addiction as a chronic illness. To address this issue, we have enclosed an article by NIDA (National Institute on Drug Abuse) Director Alan Leshner, “Addiction is a Brain Disease and It Matters,” published in the journal Science, which proposes a scientific approach to addiction and addiction treatment.  Also enclosed is an article by PLNDP Project Director David C. Lewis, “A Disease Model of Addiction,” which discusses how addiction fits as neatly into disease models as other conditions that are generally accepted as chronic, relapsing illnesses, like coronary heart disease (CHD), diabetes, or obesity.

If you have any questions or information useful to other Medical Student Associates, please feel free to call me, to contact the PLNDP National Project Office, or to use the web forums available on our website. I am a student at the Cornell University Medical College and will continue to serve as the coordinator of the Medical Student Associates group for this year.  My phone number is 212-988-1384, and the PLNDP email address is plndp@brown.edu . I encourage you to send messages often because your input will continue to significantly affect the activities of this group.

Sincerely,

Shantanu Agrawal
PLNDP Medical Student Associate Coordinator

PLNDP Colloquium at the Aspen Institute

The PLNDP leadership met again this past June at the Aspen Institute.  An important goal of this meeting was to facilitate dialogues between various disciplines in order to arrive at shared goals and to articulate the necessary steps in national and local research and advocacy efforts. To this end, representatives from law, the enforcement community, business leaders, legislators, community coalition leaders, and experts in addiction medicine and addiction psychiatry were present. Some attendants representing these different areas include Sally Hillsman, JD, the Deputy Director of the National Institute of Justice, Hubert Williams, the President of the Police Foundation, Judge Thomas A. Clark, past President of the American Judges Association, Hoover Adger, Jr. MD, MPH, President of the National Association for Children of Alcoholics and former Deputy Director of the ONDCP, and Alan Leshner, PhD, Director of the National Institute on Drug Abuse. An AP reporter present at the meeting resulted in coverage that appeared in newspapers nationwide. Participants responded positively to the idea of working together to influence drug policy, and the enthusiasm following this meeting has reinforced the need to continue on our path towards more effective treatment policies.

Article ABSTRACTS

Lewis, DC. A Disease Model of Addiction.  Principles of Addiction Medicine.  (Chevy Chase, MD: American Society of Addiction Medicine, 1994): Chapter 7.  The definition of a disease is vague enough to encompass many illnesses that are labeled as diseases. However, addictions and psychiatric disorders have been forced to conform to more specific definitions of disease, even though there are many similarities between addictive and psychiatric disorders and diseases such as diabetes mellitus and gout.  Alcoholism is comparable to accepted diseases such as essential hypertension, coronary heart disease (CHD), diabetes mellitus, and gout.  The evidence supporting the biological basis of alcoholism parallels the evidence for CHD and diabetes mellitus – they all are sometimes inherited and have physical effects on the body. Also like other diseases, alcoholism displays signs and symptoms which vary greatly. The question of control versus etiology plays an important factor in defining alcoholism as a disease; the onset of diseases such as essential hypertension or diabetes mellitus partially depend on peoples’ diet control, just as the onset of alcoholism partially depends on peoples’ control of alcohol consumption.  Alcoholism must be considered within a biopsycho-social model – a biological, psychological, and social environment – to understand the etiology of diseases, from alcoholism to CHD to diabetes.

Leshner AI.  Addiction is a Brain Disease, and It Matters. Science (3 October 1997) 278: 45-48.  Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society’s overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.

Medical Student Associate Directory on the Web

We are pleased to announce that we have created a PLNDP Medical Student Associate Directory on the web.  The Directory has been created to promote contact among Medical Student Associates.  We would like to encourage you to share your ideas and combine efforts with other medical students in your local area as well as nationwide. In order to access the Directory, please contact the PLNDP program office at plndp@brown.edu or phone 401-444-1817.

For your protection, the Directory is not linked to any of the PLNDP webpages or to the Medical Student Associate website, so you will have to type in the name of the website in order to access it. This was done so that only other Medical Student Associates will be aware that the Directory even exists

PLNDP Video for Cable

A 28-minute video, which combines footage from the PLNDP’s past two videotape reports, “Drug Addiction: The Promise of Treatment” and “Trial, Treatment, and Transformation,” is currently being developed for use on cable television. The new cable version, entitled From Hopelessness to Healing, will be made available to both local and national cable stations and should be ready by the end of this month. If you are interested in helping to distribute the latest PLNDP video or want to broadcast it on your local cable television station, please contact Kathryn Cates-Wessel by email plndp@brown.edu or by calling 401-444-1816.

Policy Update

On June 7, 1999, President Clinton directed the U.S. Office of Personnel Management to achieve parity for insurance coverage of both mental health and substance abuse for the Federal Employees Health Benefits Program (FEHBP) by 2001.  The FEHBP is the largest employee-sponsored health insurance program in the country, covering about 9 million people, including federal employees, retirees, and their families.  The President noted that the FEHBP will set a good example for other employers and the insurance industry, encouraging them to cover the costs for treating mental health and substance abuse problems in the same way they cover other health costs.  The President was also careful to point out two facts: (1) parity is not only beneficial, but also affordable; and (2) mental health and substance abuse health care costs will be appropriately managed, in much the same way other health care costs are already managed. For more information on parity, you can review the PLNDP Parity Fact Sheet that was enclosed with your September 1998 newsletter on the web.

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